Upper limb measurement and rehabilitation method and system

Abstract

A method for measuring an upper limb reaching capability of a user with an impaired limb is provided. Each upper limb is placed at a default position on a horizontal surface. A target is displayed from among a plurality of targets on the horizontal surface. One of the limbs reaches for the target. Limb choice, position information and elapsed time are sensed and recorded. The reaching limb is retracted to the default position. The displaying step through the retracting step are repeated for each of the plurality of targets, wherein each of the plurality of targets is spaced apart.

Description

BACKGROUND OF THE INVENTION[0001]1. Field of the Invention[0002]This invention pertains to the field of rehabilitation patients with stroke. More particularly, the invention relates to methods and systems for rehabilitation patients with stroke.[0003]2. Description of Related Art[0004]Stroke is the leading cause of disability among American adults. Each year in the U.S., approximately 750,000 people suffer strokes and of those, nearly 400,000 survive with some level of neurological impairment and disability. Nearly three million people are affected by stroke-related disability, and the estimated financial burden is thirty billion dollars annually.[0005]After stroke-hemiparesis or other brain lesions, one of the most important patient-centered goals is voluntary use of the paretic arm in daily life. Statistics indicate that over 80% of first-time strokes (infarctions only) involve acute hemiparesis of the upper limb that significantly affects the functional independence and health of...

AI Technical Summary

Benefits of technology

[0013]The present invention provides a method to measure voluntary paretic arm use, non-use and function in a quantifiable and repeatable manner for arm and hand function. Arm use is determined by free choice and is measured by instructing subjects to reach for targets on a two-dimensional workspace using the arm of their choice (free choice). Arm function is determined by forcing the use of an affected hand and measuring the performance on tasks. Arm non-use is measured by contrasting the probability of reach in a forced use sequence to the probability of using the arm in a free choice sequence. In other words, non-use is determined by comparing what a user can do with the affected arm (function) to what the user actually does (use) on the same tasks. The above-described method and system to measure paretic (impaired) arm use and non-use is simple to administer and requires minimal training of the participant and test administrator. The measurements are repeatable and provide reliable results.

[0014]The present invention is also suitable for use in rehabilitation of patients with motor impairment of an upper extremity resulting from stroke. The present invention provides a significant contribution to the field of stroke rehabilitation by addressing the need for a device that will deliver intensive task-oriented practice to patients at a relatively low cost with only minimal supervision by a rehabilitation therapist.

[0015]Furthermore, the present invention provides repetitive task practice with real-world challenges, and presents functional tasks automatically. A plurality of tasks are included and are controlled by an adaptive performance-based task controller that varies a plurality of parameters optimized for each patient. Adaptive training is understood as a computer processor determining the schedule of tasks to perform without relying primarily on user input. The limb rehabilitation system adapts the tasks to be performed to the patient, such that every patient can perform the task he or she is capable of, while continually being challenged and optimally stimulated by a variety of tasks. A critical means to improve functional outcomes in patients with stroke-related disability is to increase dramatically the amount of task practice, while maintaining overall costs at a reasonable level. One possible method to increase practice time in a cost-effective manner is to supplement the patient's one-to-one interaction with a physical therapist with sessions on an automated task practice system. In one embodiment of the present invention, a limb rehabilitation system is designed specifically to enhance the functional outcomes of patients with post-acute stroke who have deficits in motor tasks that require reaching and manipulation. The system can dramatically increase practice time, accurately monitor a patient's performance, and present a variety of challenging tasks adaptively to significantly improve the functional outcomes cost-effectively. The above and other objects of the present invention are achieved by a rehabilitation system in accordance with embodiments of the present invention and methods for using thereof.

Problems solved by technology

Nearly three million people are affected by stroke-related disability, and the estimated financial burden is thirty billion dollars annually.

Of all impairments that result from stroke, traditional rehabilitation methods are the least effective in treating hemiparesis of the upper limb.

In addition, stroke often leaves individuals unable to perform functional movements with the impaired limb even though the limb is not completely paralyzed.

Such methods to measure non-use are not often practical, or even reproducible, given the nature of the tests.

The MAL suffers from numerous drawbacks: 1) it relies on the participant's memory; 2) it takes at least one hour for a trained interviewer to conduct and score; 3) participants with discordant stroke may choose to not perform certain activities with the paretic hand simply because it is their non-dominant hand, thereby affecting the sensitivity of the MAL.

However, since the participants must be unaware of the videotaping, the test is time-consuming and difficult to administer repeatedly.

Because we do not have good quick tests at present, therapists cannot accurately quantify progress of patient in normal clinic and cannot design effective individualized therapy.

Other tests measure arm and hand function and impairments (e.g. Fugl-Meyer and WMFT), but are also lengthy and are not practical to administer given the often limited contact time between physical therapists and patients.

Another problem with conventional medical rehabilitation models is that they are largely constrained by economic considerations (i.e., how many sessions the patient's health insurance will cover) and are therefore not adequate to maximize functional outcomes.

Further, due to the belief that therapy is only marginally effective, health insurance companies often reject requests for rehabilitation past 3 months post stroke.

Current robots do not retrain functional tasks such as those requiring tool and object reaching and manipulation with grasping.

However, they are mostly limited to large research and clinical centers because they are expensive, complex to maintain, and require supervision and / or assistance to use.

Outside the clinical setting, there is no robotic assistance available.

Therefore, the effectiveness of conventional robots is limited.

These solutions suffer from their expense, complexity and the need for well-trained supervision.

However, these systems do not address the need for active motor learning in the rehabilitative process through adaptive training on a plurality of functional tasks involving reach, grasping and manipulation.

Simple VR, which is without the use of a robot, typically does not allow natural movement.

Therefore, there is difficulty in transferring motor learning in a VR environment to a real world environment with physical objects.

This adaptation may especially be difficult for older stroke victims to overcome and some may not be able to perceive the virtual world without discomfort.

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